Medication Therapy Management Team Handles Toughest Cases

Coordination of care can sometimes resemble a complicated labyrinth of touch-points and requirements. But the HFPN Medication Therapy Management program (MTM) offers exceptional coordination of prescription management without this complexity.

At discharge, we automatically enroll any Henry Ford patient considered high-risk for hospital readmission or ED visits because they may not use their medication properly. Enrollment is coordinated with the primary care physician to ensure full visibility.

Since the inception of the MTM program, the team of clinical pharmacists has helped scores of patients realize the full benefits of medication intervention. One recent success involved an 82-year-old diabetic patient who had been hospitalized twice in a one month period after falling. This patient was on a total of 16 different medications.

Mona Chahine, Pharm.D. determined that the fall risk might have been due, in part, to an improper dose of gabapentin to treat diabetic neuropathy. Gabapentin was being used along with regular insulin and insulin NPH, which raised another red flag, as regular insulin and insulin NPH are not normally used together.

“The use of gabapentin must be dose-adjusted to account for a patient’s kidney function, and this patient had declining kidney function; thus, the medication dose needed to be adjusted,” Dr. Chahine said. “Otherwise, the medication may accumulate in the body with declining kidney function, and the risk of adverse reactions increase. And one of the potential side effects of the medication is dizziness and drowsiness, and increased fall risk.”

Dr. Chahine also recommended that the patient stop using regular insulin, as her HgbA1c was well controlled and she had a recent episode of hypoglycemia, which may have potentiated the risk of falling. She advised the continued use of insulin NPH and the monitoring of her blood glucose.

These recommendations were communicated to the patient’s primary care physician via Epic and in person, and via email to the home health care RN. The patient’s chart was also updated to reflect these adjustments. Dr. Chahine then contacted the patient by phone to explain the proposed changes, why they were being made and what positive results she could expect with these changes. She ensured the patient understood these changes by asking her to repeat back the new plan, which she did.

This patient has not had a hospital readmission since these changes were made, in January of this year.

“The entire MTM team is dedicated to providing our specialized care for all of our HFPN docs and their patients,” Dr. Chahine added.